By Leigh Kimberg, MD
Each day, an overwhelming majority of our patients arrive in clinic wishing that their healthcare providers would ask them questions about how their personal relationships affect their health and, more specifically, whether an intimate partner, family member or other person has hurt or threatened them. And, despite the requirement by the Affordable Care Act that all women and girls be offered interpersonal violence (IPV) (intimate partner violence and sexual assault) screening, brief counseling and referral, healthcare providers and healthcare systems have not institutionalized this practice. “Aspire to Realize Improved Safety and Empowerment” (ARISE), a partnership program newly funded by the Office of Women’s Health in the US Department of Health and Human Services, will fully institutionalize these life-saving practices in the San Francisco Health Network primary care system.
IPV has a devastating impact on the health and well-being of women and girls. When rape, physical violence and stalking are combined, more than one in three of women in the US have been victims of IPV. This violence results in a myriad of acute and chronic poor physical and mental health outcomes including sexually transmitted infections including HIV, cardiovascular disease, chronic pain, depression and suicide attempts. We now know that counseling and safety planning interventions delivered in primary care setting are effective in improving safety and reducing violence.
Recently, Californians were asked about the role of healthcare providers in “domestic violence” (DV) prevention in an independent survey commissioned by the Blue Shield Foundation, 87% of the respondents felt strongly that DV victims should seek outside help rather than trying to cope with this damaging and dangerous dynamic privately within the family. Yet, 91% of the respondents felt that “DV victims can be just as afraid of going to the police as they are of facing their abuser”. The most trusted sources of assistance were “DV shelter advocates” (85%) and “doctors” (83%). Most respondents, however, did not know how to reach a DV shelter advocate and had never been screened for IPV by a healthcare provider. This will change with ARISE.
ARISE will transform our primary healthcare system through innovative community partnerships to ensure that we deliver the promise of life-saving assistance to our patients and families who are affected by IPV. Healthcare providers and researchers from the Division of General Internal Medicine at San Francisco General Hospital (SFGH), University of California, San Francisco (UCSF) in partnership with the San Francisco Health Network will build upon two decades of pre-existing partnership with Futures without Violence, La Casa de las Madres, Bay Area Legal Aid and the Trauma Recovery Center to fully institutionalize our response to IPV and study new models of care.
One of our partners, the national and internationally renowned, Futures without Violence, is leading the movement funded by the Blue Shield of California Foundation to create innovative partnerships between domestic violence advocacy organizations and healthcare clinics and hospitals. Our partner, La Casa de las Madres, a community-based DV crisis, shelter and advocacy organization has experience bringing advocates to IPV survivors rather than waiting for IPV survivors to come to them through partnerships with public housing and the police department. With ARISE, La Casa de las Madres will place a full time advocate at SFGH to respond immediately to patients and parents of pediatric patients who disclose IPV in our hospital-based primary care clinics. Our legal partner, Bay Area Legal Aid (Bay Legal) will utilize their long-standing expertise in addressing domestic violence to advise healthcare providers on legal options for IPV survivors and their families. And, the Trauma Recovery Center will provide expert consultation and a continuum of care for survivors of lifetime trauma. Through these partnerships, ARISE will empower IPV survivors, improve safety and, ultimately, break the cycle of violence by preventing children from being exposed to violence within the family.